Customer Business Information
Finish & Submit
Fields marked with * are required.
(Social Security Number is required for all sole proprietorships and customers applying for a personal account.)
Required if requesting invoices sent via Email
Required if selecting 'Yes' for Order Acknowledgement Email
(If Tax Exempt, tax exemption document required in Documents section)
(Bank and Trade References must be provided to apply for a line of credit. Prepared Reference Documents may be attached in Documents section)
The Signer warrants that he/she is an authorized signer of Applicant. The Signer acknowledges that the information provided is for the purpose of the Applicant obtaining an account with Lubrication Technologies Inc., Lube-Tech & Partners, LLC, Lube-Tech Equipment Service Installation, Inc. (ESI) and Lube-Tech Liquid Recycling, Inc., cumulatively doing business as Lube-Tech, and warrants the information herein to be true.The Applicant assumes all payment liability on all sales and contracts under this account. Applicant agrees to pay all invoices within payment terms of Net 10 days for fuel products and services and Net 30 days for lubricants, chemicals, equipment, and any other non-fuel products and services, upon date of invoice on any invoices billed through Applicant’s approved line of credit. Applicant agrees to approve Lube-Tech to securely store any payment card information pursuant to the Payment Card Industry Data Security Standard. Payments by credit card are subject to a 3.1% processing fee surcharge. The Applicant further agrees that in the event the account becomes delinquent that the Applicant will be responsible for payment of all costs of collection, including, but not limited to, collection agency fees, attorney fees, and court costs.The Applicant authorizes the referenced bank, trade vendors, and all credit bureaus to release account information for the purpose of establishing credit with Lube-Tech. It is further agreed that the Applicant will notify Lube-Tech in writing, by certified mail, of any change in address, ownership, management, legal identity, or termination and/or succession of the business operations by any other person or entity.Any information entered into this form is solely for the use of establishing an account with Lube-Tech and will not be shared or distributed outside of Lube-Tech.